The deadly triumph of statistics

What were they thinking? A panel of scientists has issued guidelines for breast-cancer screening that could undo years of education and advocacy that have saved tens of thousands of lives. In a report that smacks of health-care rationing, the U.S. Preventive Services Task Force recommends that instead of annual mammograms after the age of 40, women should wait until age 50 to receive regular screening, and then only every other year instead of annually.

“They acknowledge more women between 40 and 49 will die,” sputters Florida Democrat Debbie Wasserman Schultz, who has introduced legislation aimed at making women in the under-50 group more aware of their breast-cancer risks. As someone diagnosed at 41, the congresswoman knows how important it is for women in that age range to understand that the tumors they develop are likely to be more aggressive and diagnosed at a later stage than those of older women. That’s why breast cancer is the No. 1 cancer killer of women between the ages of 40 and 49.

Given that, why would a prestigious government panel make this ridiculous recommendation? Statistics. (As in, “There are lies, damn lies and statistics.”) Even though, as the group admitted, 40-year-olds who are screened are 15 percent less likely to die of breast cancer than women who don’t have mammograms, the members apparently found other numbers more compelling: 1,904 women in their 40s have to be screened to prevent one breast-cancer death. Tell that to the kids of the 45-year-old whose life was saved by mammography. Ask them what they think of those statistics!

In what can only be described as insulting conclusions, the panel judged that the number of false positives – people whose screenings turn up something that a biopsy shows is not cancer – and the number of slow-growing, nonlethal cancers unnecessarily treated cause a high level of anxiety among women. Please. Are women such delicate flowers that they can’t handle a few days of worry versus the possibility of death? These are people, after all, who raise teenage sons. “It’s patronizing to assume that women are going to get hysterical over information,” insists Wasserman Schultz. “They are basically saying we know more women will die, but saving 1,900 from angst is more important.”

Though some doctors say they will ignore the new guidelines, the real danger here is that insurance companies will use these recommendations as an excuse to stop paying for mammograms, after years of militancy to make mammography coverage a legal requirement in most states. Advocates thought the fight had finally been won in 2003 when the American Cancer Society endorsed regular mammograms starting at age 40. That group’s chief medical officer, Dr. Otis W. Brawley, issued a statement vowing to stick with that decision: “As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over.”

Already there’s evidence that these wrongheaded recommendations mean fewer women are showing up for their potentially lifesaving screening. There’s nothing fun about a mammogram. But after years of drumming in the message that early detection saves lives, close to two-thirds of women in their 40s and more than 70 percent of women over 50 say they have had the test in the past two years. Funny thing – that increase in screening coincides with the decrease in mortality from breast cancer, by about 2 percent a year since 1990. How could it make sense to stop those strides in their tracks?

Women are now confused about what they should do – even high-risk women the panel says should continue regular screenings. Wasserman Schultz points to her own example – she, an educated woman who had worked on breast-cancer bills as a state legislator, had no idea that she was at an increased risk for breast cancer because she is an Ashkenazi Jew. Once she learned she had breast cancer, she also learned that she carried the gene predisposing her to the disease.

The congresswoman is now battling to make sure that insurance companies and the Department of Health and Human Services don’t adopt these recommendations, which could be toxic not only for women but for health-care reform. The panel has provided excellent talking points for radio-talk-show hosts screaming that the legislation will result in rationing. These statistically minded scientists were at best naive, at worst unethical.

What were they thinking?

Cokie Roberts’ latest book is “Ladies of Liberty: The Women Who Shaped Our Nation” (William Morrow, 2008). Steve and Cokie Roberts can be reached at stevecokie@gmail.com.

Copyright 2009, Steven and Cokie Roberts.

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